J Surg Educ. 2025 Nov 7:103734. doi: 10.1016/j.jsurg.2025.103734. Online ahead of print.
ABSTRACT
OBJECTIVE: Surgical residents are increasingly pursuing fellowship after general surgery (GS) residency. Fellowship comes at significant opportunity cost and can alter career earnings. This study aims to quantify the return on investment of surgical fellowships when compared to direct entry into GS practice.
DESIGN: Using traditional financial analysis tools including net present value (NPV) and breakeven analysis we compared annual salaries for general surgeons to that of surgeons completing one of ten fellowships. Using AAMC academic and MGMA private practice salary data we estimated income over a 35-year surgical career. Modeling for those pursuing fellowship included both a 5-year and a 7-year GS residency training path accounting for possible research time. GS residency was modeled at 5 years of training. We modeled based on both academic and private practice careers.
SETTING: This study includes survey responses from surgeons across all common practice and hospital types in the United States.
PARTICIPANTS: Participants in the MGMA survey used in our analysis are private practice surgeons in the United States. Participants in the AAMC survey used in our analysis are academic surgeons.
RESULTS: Academic Cardiothoracic, Plastic, and Pediatric surgery had a positive NPV even when accounting for 7 years of trainee salary. This reflects a positive return on investment. Those pursuing Vascular surgery fellowship had a positive NPV if they completed GS training without research time. Private practice Cardiac, Thoracic, Plastic, Vascular and Pediatric surgeons had a positive NPV without added research time. If residency training includes research time only Cardiac and Pediatric surgery are NPV positive. Breast, Surgical Oncology, Trauma, Colorectal and Transplant fellowships confer negative NPVs for both academic and private practice even when modeled in a 5-year training paradigm. Trauma surgery had a positive NPV when adjusting for hours worked.
CONCLUSIONS: This analysis highlights the significant impact that fellowship training has on career earnings and underscores the opportunity cost of research years. These data offer a transparent financial analysis to help guide surgical residents in career decisions as they weigh personal values, interests, financial stress and fiscal expectations.
PMID:41206270 | DOI:10.1016/j.jsurg.2025.103734
